Peptide receptor radionuclide therapy in patients with medullary thyroid carcinoma: predictors and pitfalls

Carolien M Beukhof,Gaston J H Franssen,W Edward Visser,Tessa Brabander,Wouter W De Herder,Francien H Van Nederveen,Leo J Hofland,Boen L R Kam,Yolanda B De Rijke,Lideke A C Fröberg,Robin P Peeters,Marie-Louise F Van Velthuysen

doi:10.1186/s12885-019-5540-5

Carolien M Beukhof, Gaston J H Franssen + Show 10 more

Open Access

https://doi.org/10.1186/s12885-019-5540-5

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Journal: BMC Cancer	Publication Date: Apr 5, 2019
Citations: 38	License type: open-access

Affiliation: Erasmus MC

Abstract

BackgroundFor progressive metastatic medullary thyroid carcinoma (MTC), the available treatment options with tyrosine kinase inhibitors result in grade 3–4 adverse events in a large number of patients. Peptide Receptor Radionuclide Therapy (PRRT), which has also been suggested to be a useful treatment for MTC, is usually well tolerated, but evidence on its effectivity is very limited.MethodsRetrospective evaluation of treatment effects of PRRT in a highly selected group of MTC patients, with progressive disease or refractory symptoms. In addition, a retrospective evaluation of uptake on historical 111In-DTPA-octreotide scans was performed in patients with detectable tumor size > 1 cm.ResultsOver the last 17 years, 10 MTC patients were treated with PRRT. Four out of 10 patients showed stable disease at first follow-up (8 months after start of therapy) whereas the other 6 were progressive. Patients with stable disease were characterized by a combination of both a high uptake on 111In-DTPA-octreotide scan (uptake grade ≥ 3) and a positive somatostatin receptor type 2a (SSTR2a) expression of the tumor by immunohistochemistry. Retrospective evaluation of historical 111In-DTPA-octreotide scans of 35 non-treated MTC patients revealed low uptake (uptake grade 1) in the vast majority of patients 31/35 (89%) with intermediate uptake (uptake grade 2) in the remaining 4/35 (11%).ConclusionsPRRT using 177Lu-octreotate could be considered as a treatment in those patients with high uptake on 111In-DTPA-octreotide scan (uptake grade 3) and positive SSTR2a expression in tumor histology. Since this high uptake was present in a very limited number of patients, this treatment is only suitable in a selected group of MTC patients.

Highlights

For progressive metastatic medullary thyroid carcinoma (MTC), the available treatment options with tyrosine kinase inhibitors result in grade 3–4 adverse events in a large number of patients
111In-DTPA-octreotide scans We retrospectively reviewed 111In-DTPA-octreotide scans between 1999 and 2011 of non-treated MTC patients that were performed in metastatic MTC
This study reports the results of 10 patients with metastasized MTC that were treated with Peptide Receptor Radionuclide Therapy (PRRT) using 177Lu-octreotate

Summary

Introduction

For progressive metastatic medullary thyroid carcinoma (MTC), the available treatment options with tyrosine kinase inhibitors result in grade 3–4 adverse events in a large number of patients. Peptide Receptor Radionuclide Therapy (PRRT), which has been suggested to be a useful treatment for MTC, is usually well tolerated, but evidence on its effectivity is very limited. In a second trial treating 7 MTC patients with 177Lu-octreotate, 3 patients had PR, 3 patients had stable disease (SD) and 1 patient progressive disease (PD) [14] These results suggest that PRRT might be a useful treatment in patients with MTC, the total number of treated patients is very limited so far. We performed a retrospective evaluation of treatment with 177Lu-octreotate in our center, where it was used in a highly selected group of 10 MTC patients with progressive disease or high risk tumor localization. We evaluated possible predictors and pitfalls of 177Lu-octreotate treatment in MTC

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